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NPI Code Detail

MEDICARE: MS. CHARLENE R. SHANK

MEDICARE: MS. CHARLENE R. SHANK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerRT001469APA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12255A2300XOTHERPAATHLETIC TRAINER

General Provider Information

NPI Number : 1124243068
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHARLENE R. SHANK
Provider Business Mailing Address
First Line : 2505 BREMER RD
Second Line :
City : DOVER
State : PA
Zip : 17315-2051
Country : US
Telephone Number : 717-292-5932
Fax Number : 717-266-0616
Provider Business Practice Location Address
First Line : 300 HIGH ST
Second Line :
City : MANCHESTER
State : PA
Zip : 17345-1508
Country : US
Telephone Number : 717-266-3644
Fax Number : 717-266-0616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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Directions to “ MS. CHARLENE R. SHANK ” Practice Location

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